Biomedical subjects
Publications and source records attributed to A Berenguer.
Although systemic vasculitis can be a complication of inflammatory bowel disease at several locations (skin, eyes, brain, mesentery, and lung) the association of retinal vasculitis with Crohn's disease is rare. We studied a 26-year-old woman with biopsy-demonstrated Crohn's disease who developed a severe bilateral retinal arteritis and phlebitis, with acute loss of vision.
A case of acute renal failure with characteristics of interstitial nephritis associated to treatment with mesalazine (5-ASA bound to resin) in a 26-year old patient with a 7-year history of Crohn's disease is presented. The patient had been previously treated with 5-ASA with no alterations in renal function being observed. Renal failure became manifest several days after initiation of maintenance therapy with 5-ASA during the latest outbreak of intestinal inflammatory disease and disappeared upon suppression of the drug.
We report two patients with large-cell non-Hodgkin's lymphomas who were treated with intensive chemotherapy (MACOP-B), and in whom large isolated intraparenchymal masses (splenic in one case, renal in the other) were found with computed tomography after clinical remission. It was found at surgery that both masses were constituted by acellular necrotic material, without tumoral infiltration and limited by fibrous tissue. The finding of these residual masses in patients in remission raises problems of approach, as they may be nontumoral and not require new therapy. At present, until new radiological or biochemical markers are available, a judicious clinical attitude should be taken, with radiological control of the evolution of the masses and reserving surgery only for those cases with progression, diagnostic doubts, or patient's decision to know his real status.
Hypertension and bruit over the graft are commonly associated to renal arterial stenosis in transplant patients. However, these findings can have other origins, too. In the present work we report on two patients in whom remote arteriovenous fistulas were the cause of a spurious bruit heard over the kidney allograft.
We report a case of lymphorrhea after living donor nephrectomy. Clinically the donor presented with an increased flow of a liquid characteristic of lymph, which was treated successfully with iodinated povidone. The possible pathogenic mechanisms implicated in the development of lymphocele following renal transplantation are discussed.
We report 7 cases of bone tissue in the upper urinary tract. Routine excretory urography was suspicious for renal lithiasis. However, pathological evaluation of the kidney tissue revealed bone metaplasia in all 7 cases. Retrospective examination of the first 6 cases showed a typical radiological sign, consisting of a radiopaque eccentric halo surrounding an area of lesser radiological density that, in turn, connected with the urothelium. These findings permitted a correct preoperative diagnosis of bone metaplasia in case 7. Accurate preoperative differentiation of bone metaplasia (false calculi) and true renal lithiasis is important owing to the different treatments required.
Eighteen lymphoceles developed after 199 renal transplantations, 11 being asymptomatic. Ultrasound was the most sensitive method of detection. Seven lymphoceles were symptomatic, pelvic mass and decreased renal function being the most frequent signs. Five lymphoceles were successfully treated by instillation of iodate povidone into the lymphatic cavity; there were no complications or recurrences. This is a simple, safe and inexpensive method for the treatment of lymphoceles after renal transplantation.
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A case of milk-of-calcium with an exceptional location is reported. The characteristics of milk-of-calcium are presented, with stasis and urinary tract infection being the most important etiologic factors in this case. Structurally the stones are formed by a central core of calcium phosphate surrounded by magnesium-ammonium phosphate (struvite).
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We analyze our experience in 175 patients with transitional bladder cancer for whom radical cystectomy was indicated. Patients were divided into three groups: one group was managed with radical cystectomy only and the other two with pre-operative radiotherapy: long-term approach and short-term approach. No significant differences have been observed when comparing current survival rate and disease-free intervals of all three groups. It can be deduced from our series that, by the scarce number of local recurrences observed, there is no other measure to be added to surgery directed to improve the tumour's local management. Most metastasis were diagnosed within 18 months after cystectomy. 58.4% patients presented bone dissemination. The risk of distant dissemination increases with the extent of vesical wall invasion, degree of anaplasia and presence of positive glands. The gland stage is not necessary for the metastasis to be present. Death's ratio with distant dissemination is significantly lower in the group managed Without pre-operative radiotherapy than in the others. Of the 11 patients where no tumour was observed in the cystectomy piece, 2 developed metastasis, indicating that this was already present before bladder extraction. Management of patients with infiltrating++ bladder cancer is complex, but no efforts should be spared to advise the most appropriate approach for each particular case. Chemotherapy plays an unquestionable role among the procedures we have to control, since most patients' deaths happen within two years after local-regional treatment of the primitive tumour and nearly all of them as a consequence of metastasis. Cytostatic agents are the only effective therapy for distant dissemination. We believe that every patient with a cancer extended to the perivesical fat or with dissemination to regional glands, whichever the stage, should be treated with chemotherapy after extirpation of the bladder, and starting as early as the patient's general status would allow it.
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